Blood Lithium Levels Research Articles

Clinical subtypes of cluster headache and response to lithium therapy.

SYNOPSISBased on clinical features, a group of 31 patients with cluster headache was divided into 1) episodic cluster headache, with months or years of headache free intervals, 2) chronic cluster headache without significant headache free intervals. Chronic type could be subdivided into primary and secondary varieties, secondary being a transformation from episodic cluster headache. A clinical trial of Lithium Carbonate was undertaken. Blood levels of lithium were determined at regular intervals to monitor the therapeutic dosage. Lithium was found to be an effective prophylactic agent in both episodic and chronic cluster headache patients. The percentage of improvement based on headache index was as follows: 55% of patients had more than 90% improvement; 10% of patients showed 60–90% improvement; 15% of patients showed 25–60% improvement; and 20% no improvement. Effectiveness of lithium was evident in less than a week after the initiation of treatment in those who responded. 55% of patients showed mild side effects such as tremor, nausea, diarrhea, abdominal discomfort and lethargy. Only one patient had serious side effects which needed discontinuation of therapy.The beneficial effect of lithium on cluster headaches appear to be independent of its anti‐depressant action. Mechanism of action of lithium in cluster headache is not clear.

Mania in childhood. II. Therapeutic trial of lithium carbonate and further description of manic-depressive illness in children.

Six children with childhood mania were identified using established diagnostic criteria. Poor response to tranquilizers led to a therapeutic trial of lithium carbonate. Outpatient administration of lithium carbonate in dosages of 30 to 40 mg/kg/day produced therapeutic blood lithium levels, and improved manic symptoms in all six children. Two of the children had a prolonged remission of symptoms with the lithium treatment. Lithium was discontinued in three patients whose depressive symptoms were uncontrollably worsened. Electroencephalographic epileptiform activity developed in one child receiving lithium carbonate. Using the strict diagnostic criteria for childhood mania, further therapeutic trails including double-blind studies are indicated to establish the proper role of lithium carbonate in the treatment of this disorder.

Lithium Carbonate Toxicity

To the Editor.— The article of F. A. Herrero on lithium carbonate toxicity (226:1109, 1973) deserves comment. Some authorities believe lithium carbonate is one of the most underused neuroleptic drugs. Though considered safe within the appropriate therapeutic range (0.6 to 1.2 mEq/liter), it is always important to know about idiosyncrasies, so that physicians may take appropriate measures. Awareness of these unusual cases, however, should be created without stimulating exaggerated fears that may inhibit use in cases where lithium is clearly indicated. Both the report and the editorial note fail to recognize recent findings suggesting that appropriate treatment for acute manic episodes should include phenothiazines or butyrophenones. This treatment method is more effective in controlling the initial symptoms of hyperactivity during the waiting period of seven to ten days necessary for lithium activity. It also decreases the need for blood lithium levels as high as 1.5 mEq/liter, thus lowering the risk

Disposition of lithium and magnesium following intravenous administration to pregnant animals

Following the administration of 5.5 mg. per kilogram lithium or 160 mg. per kilogram magnesium sulfate, the maternal blood, fetal blood, amniotic fluid, and chorionic fluid of pregnant mongrel dogs were analyzed for the presence of these substances. When maternal blood levels of lithium were maintained at 0.45 ± 0.15 mEq. per liter for 2 hours. lithium did not appear in the fetal blood, amniotic fluid, or chorionic fluid. When the maternal blood level of lithium approached 3.0 mEq. per liter in one animal, traces of lithium appeared in the fetal blood but not in the amniotic or chorionic fluid. Maintaining the maternal blood level of magnesium at 6.1 ± 4 mg. per cent for 2 hours was not sufficient to produce a significant increase in the level of magnesium in the fetal blood, amniotic fluid, or chorionic fluid. Moderately elevated maternal blood levels of lithium or magnesium do not produce rapid transfer of these substances to the fetal circulation.

Acute brain syndrome associated with lithium therapy.

Three patients who were treated with lithium displayed symptoms resembling those of organic brain syndrome when their blood lithium levels were low. All patients' lithium levels were slow to rise. When lithium was stopped, the patients' blood levels began to rise and then fell, at which time their symptoms remitted. The authors postulate that this lithium toxicity may possibly be due to tissue lithium levels.

EFFICACY OF LITHIUM AS ACUTE TREATMENT OF MANIC-DEPRESSIVE ILLNESS

A double-blind comparison of alternating 7-10 day periods of lithium and placebo in thirty-eight manic-depressive inpatients demonstrated a significant advantage of lithium over placebo in mania. Median mania ratings after 56 periods of lithium (0.5 meq. per kg. per day) in twenty-eight patients decreased significantly, but did not decrease significantly after 42 periods of placebo in twenty-eight patients. Mania decreased in 75% of lithium periods and worsened in only 7%; mania decreased in 40.5% of placebo periods and increased in 40.5%. Median mania ratings during days 7-10 of treatment were significantly lower after lithium than after placebo, even though mania ratings immediately preceding lithium tended to be higher. In the initial treatment periods alone, patients receiving lithium had significantly lower ratings after treatment than patients receiving placebo. " Atypical " manic-depressive (manic) patients responded as well as did apparently typical cases. There was no significant correlation between lithium blood-levels and a decrement in mania ratings during days 7-10 of lithium treatment with the blood-levels attained (mean 0.93 meq. per litre) and the relatively low dose used. In 26 treatment periods in eighteen patients begun during behavioural depression, the 59% improvement-rate with lithium was not significantly higher than the 48% rate with placebo.

Klinische Behandlungsversuche des lithiumbedingten Tremors durch einen β-Rezeptorenantagonisten (Propanolol)

The paper describes the theoretical and experimental basis of lithium action, tremor as the main side effect, and the attempt of treating tremor in Parkinson’s disease by administration of β-receptor blockers. A review is presented of β-receptor and propanolol action, as well as its relation to lithium-induced tremor. 15 of own cases, 10 of which were affected by lithium-induced tremor and the other 5 by psychogenic tremor, were treated by 2 X 40 mg (or 4 X 20 mg) propanolol over a period of 7-28 days under permanent supervision of lithium blood level. The ten lithium-treated patients belong to the following diagnostic groups: manic-depressive psychosis, endogenous depression, ‘vitalised’ neurotic depression and schizo-affective psychosis. Out of the 8 positive results obtained, 3 were satisfactory and 5 excellent. No side effects were observed. Tremor modifications were objectivated by writing and drawing tests. Further possibilities for more detailed studies are discussed.